刘丽 孙静 袁福静

[摘要] 目的 评价结构化宣教在行全膝关节置换术患者中的应用价值。 方法 选取2014年1月～2017年11月在鄂州市中心医院骨科住院的行全膝关节置换术的患者210例，按照住院号单双数将患者随机分为干预组和对照组，每组105例。对照组采用常规护理措施，干预组采用结构化宣教。分别于术后1、2周、术后3个月采用关节活动度评估膝关节功能改善情况，视觉模拟评分量表（VAS）评估疼痛情况，自我效能感量表评估患者术后自信心恢复情况，并测量患者对护理工作的满意度。 结果 与术后1周比较，两组患者随着术后康复时间延长，其膝关节活动力度、自我效能感评分明显增加，VAS评分明显降低，差异有高度统计学意义（P < 0.01）。干预组术后1、2周、术后3个月膝关节活动度（ROM）、VAS评分、自我效能感评分均显著高于对照组（P < 0.01），术后2周护理工作满意度均高于对照组（P < 0.01）。 结论 结构化宣教能提高行全膝关节置换术（TKA）患者膝关节功能，减轻疼痛，提高自我效能感，并提高护理满意度。

[关键词] 结构化宣教;全膝关节置换;应用价值

[中图分类号] R473.6          [文献标识码] A          [文章编号] 1673-7210（2019）03（a）-0166-04

[Abstract] Objective To evaluate application value of structured education on patients with total knee arthroplasty. Methods According to the single and double numbers of the hospitalization number，210 patients with total knee arthroplasty in Department of orthopedics of  Ezhou Central Hospital from January 2014 to November 2017 were randomly divided into intervention group and control group， with 105 cases in each group. The control group adopted routine nursing measures， and the intervention group adopted structured education. Knee function improvement after operation 1 weeks， 2 weeks and March were assessed by range of motion （ROM）. Visual rating scale （VAS） was used to assess pain. Self efficacy scale was used to evaluate postoperative recovery of self-confidence and nursing satisfaction. Results Compared with 1 week after operation， the ROM and self-efficacy scores of the two groups increased significantly with the prolongation of rehahilitation time， while VAS scones deereased significantly， and the differences were statistically significant （P < 0.01）. In the intervention group， the scores of ROM， VAS and self-efficacy were significantly better than those in the control group after operation 1 weeks， 2 weeks and March （P < 0.01）， and the satisfaction degree of nursing work was higher than that in the control group 2 weeks after operation （P < 0.01）. Conclusion structured education can improve knee function， relieve pain and improve self-efficacy of TKA patients. It can improve the quality of life and nursing satisfaction to the greatest extent， and is worthy of promotion.

[Key words] Structured education; Total knee arthroplasty; Application value

膝骨關节炎是多发生于老年人的膝关节软骨、软骨下骨退变，其可导致膝关节疼痛、畸形及功能障碍。全膝关节置换术（total knee arthroplasty，TKA）是治疗重度膝骨关节炎、恢复膝关节功能的最有效手术方式。Baker等[1]2007年对9417例TKA术后患者的研究提示，16.4%的患者术后1年内仍然存在膝关节的疼痛。Beswick等[2]的研究也指出20%的TKA术后患者术后半年仍存在不同程度的功能受限和疼痛。这在很大程度上影响了患者手术的依从性及术后康复训练的成功率，从而影响了患者术后患肢功能恢复程度[2]。已有大量研究证实[3-7]系统的教育管理可提高TKA患者手术依从性，改善其膝关节功能。结构化宣教是根据研究对象的教育背景和具体情况，有目的、个体化、灵活、全面综合的教育方法[4]。……